Key result
Vasoreactivity testing is used to determine indications for surgical treatment in children with pulmonary arterial hypertension associated with uncorrected congenital heart disease, but is inappropriate for assessing operability in adult patients.
Why the study?
During the approval of the first Eurasian guidelines for pulmonary hypertension associated with congenital heart disease in adults, contentious issues arose regarding the need for diagnostic tests for vasoreactivity.
Vasoreactivity testing is appropriate for determining surgical indications in children with pulmonary arterial hypertension and uncorrected congenital heart disease, but is not recommended for assessing operability in adults with congenital heart disease.
First Eurasian guidelines offer expert consensus on adult CHD-PH management; leaves open prospective validation of vasoreactivity testing.
In December, 2021 at the IXth All-Russian Congress «Pulmonary Hypertension 2021» the first Eurasian guidelines for the diagnosis and treatment of pulmonary hypertension associated with congenital heart disease in adults were approved. The expert group discussed many contentious issues, including the need for diagnostic tests for vasoreactivity. Invasive registration of the reaction of the pulmonary vessels to vasodilators – a vasoreactivity testing – in idiopathic, hereditary and drug- and toxin-induced pulmonary arterial hypertension (PAH) is used to determine indications for calcium antagonist therapy, in PAH associated with uncorrected congenital heart disease (CHD) in children – to determine the indications for surgical treatment. The use of a vasoreactivity testing to assess the operability of adult patients with congenital heart disease is inappropriate. An overview of the performance technique, specific pulmonary vasodilators and criteria for evaluating the test for vasoreactivity in various subgroups of PH associated with CHD is given.
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Shmalts et al. (2022) conducted a review in Pulmonary hypertension associated with congenital heart disease. Vasoreactivity testing was evaluated. Vasoreactivity testing is used to determine indications for surgical treatment in children with pulmonary arterial hypertension associated with uncorrected congenital heart disease, but is inappropriate for assessing operability in adult patients.
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